Table of Contents
Key Takeaways:
Nattokinase and fish oil work differently. Nattokinase is studied primarily for fibrinolytic and related cardiovascular effects, while fish oil provides the omega-3 fatty acids EPA and DHA.
Nattokinase has demonstrated effects on certain coagulation and fibrinolysis markers, but evidence showing that it prevents cardiovascular events remains limited.
Omega-3 fatty acids have been studied much more extensively, particularly for their effects on triglycerides and cardiovascular outcomes.
Results from omega-3 cardiovascular trials vary substantially according to the formulation, dose, and population studied.
Neither supplement should be considered a replacement for statins, anticoagulants, blood-pressure medications, or other physician-directed cardiovascular treatment.
Both require additional consideration for people taking medications that affect clotting or who have certain cardiovascular conditions.
Nattokinase and fish oil are both dietary supplements frequently associated with cardiovascular health, but they're fundamentally very different. Nattokinase is a fibrinolytic enzyme produced during the fermentation of soybeans into natto, while fish oil supplies omega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Their potential cardiovascular effects also differ. Nattokinase has been studied primarily for its effects on fibrin, fibrinolysis, coagulation markers, and blood pressure. Omega-3 fatty acids have a much larger body of research examining triglycerides and cardiovascular outcomes.
When comparing nattokinase vs. fish oil, there isn't a simple answer to which is "better," as the answer depends on what your goals are and where you're headed. Instead of looking for a winner, it's more useful to understand which one would be a better fit for your health priorities.
What Is Nattokinase?
Nattokinase is an enzyme produced by a type of probiotic bacteria called Bacillus subtilis during the fermentation process used to make natto, a traditional Japanese soybean food. Nattokinase is considered a fibrinolytic enzyme because of its ability to degrade fibrin under experimental conditions. Fibrin acts like a protective net, giving a blood clot its structure and helping it hold together.
Researchers have investigated both direct and indirect mechanisms through which nattokinase could influence fibrinolysis. Human studies also suggest that oral nattokinase can influence certain coagulation and fibrinolysis measurements.
In one small placebo-controlled crossover study, 12 healthy men received a single 2,000-FU dose of nattokinase. Researchers observed temporary changes in D-dimer, fibrin/fibrinogen degradation products, factor VIII activity, antithrombin concentrations, and activated partial thromboplastin time.
That's a long list of lab markers, but what you need to understand is simpler: these findings demonstrate biological activity, but they do not establish that nattokinase can prevent or treat a dangerous blood clot.
What Is Fish Oil?
Fish oil contains long-chain omega-3 polyunsaturated fatty acids. The two most commonly researched omega-3s for heart health are EPA and DHA.
Omega-3 fatty acids have several physiological functions and can affect lipid metabolism. One of their best-established cardiovascular effects is a reduction in blood triglyceride concentrations, particularly at higher therapeutic doses.
Over-the-counter supplements containing combinations of EPA and DHA should not automatically be treated as equivalent to purified, prescription-strength omega-3 preparations used in some cardiovascular clinical trials. That doesn't mean the fish oil in your cabinet is useless. It means the results from a specific trial don't automatically apply to every bottle on the shelf.
A large meta-analysis of 38 randomized trials involving more than 149,000 participants found that omega-3 fatty acids were associated with modest reductions in cardiovascular mortality, nonfatal myocardial infarction, coronary heart disease events, and major adverse cardiovascular events. The benefits were more pronounced in trials using EPA alone than in trials using combined EPA and DHA.
Nattokinase vs. Fish Oil: How Do They Work?
The fundamental difference between nattokinase and fish oil is their mechanism of action. Both are studied for cardiovascular health, but they approach it in completely different ways.
Nattokinase and Fibrinolysis
Fibrinolysis is the body's process for dismantling fibrin after a clot has served its purpose. The human fibrinolytic system normally relies on plasmin, which is generated from its inactive precursor plasminogen.
Nattokinase isn't simply a stand-in for plasmin. Experimental research suggests it may directly degrade fibrin and interact with components that regulate the body's own fibrinolysis. Clinical studies show that nattokinase can alter certain laboratory markers associated with coagulation and fibrinolysis. Whether those effects translate into fewer heart attacks, strokes, or other cardiovascular events has not been established.
Fish Oil and Lipid Metabolism
Omega-3 fatty acids like EPA and DHA influence hepatic lipid metabolism and can reduce the production of triglyceride-rich very-low-density lipoproteins. Their cardiovascular effects may also involve several other biological pathways.
Research examining triglyceride-lowering therapies has found an association between reductions in triglycerides and reductions in cardiovascular risk, although the relationship is complex and omega-3 outcomes vary considerably by formulation.
Which Has More Evidence for Heart Health?
Here, fish oil has the clear head start. Omega-3 fatty acids have been studied in considerably larger populations and more cardiovascular outcome trials than nattokinase. But more research doesn't automatically mean the answer is simple. Many trials use specific formulations and doses, and the results haven't been uniform.
A systematic review and meta-analysis of 15 randomized controlled trials found modest reductions in major cardiovascular events, myocardial infarction, and cardiovascular mortality with omega-3 supplementation. The analysis also found an increased incidence of atrial fibrillation.
Other analyses have produced more neutral results for several cardiovascular outcomes. Differences in EPA versus EPA/DHA formulations, dosage, baseline cardiovascular risk, and concurrent medical treatment likely contribute to the varying findings.
Nattokinase has a much smaller evidence base. Existing human research provides evidence for biological activity and possible effects on specific cardiovascular markers, but large trials demonstrating prevention of heart attack, stroke, or cardiovascular death are lacking.
That's why comparing mechanisms alone only tells you part of the story. Clinical outcome evidence matters more than theoretical potential.
The Bottom Line: Nattokinase vs. Fish Oil
Nattokinase and fish oil approach cardiovascular wellness from very different directions. Nattokinase is a fibrinolytic enzyme with intriguing evidence showing effects on fibrin-related, coagulation, and cardiovascular markers. Clinical research is still limited, but the early findings are encouraging, and research into nattokinase's long-term outcomes continues to develop.
Fish oil has a substantially larger clinical evidence base. Omega-3 fatty acids can reduce triglycerides, and some studies have demonstrated cardiovascular benefits, particularly with certain EPA formulations and populations. At the same time, results across cardiovascular trials are inconsistent, and higher doses may increase atrial fibrillation risk in some people.
The right choice for you depends on the specific cardiovascular goal, medical history, medications, and the type and dose of supplement you’re considering. Neither nattokinase nor fish oil should be treated as a universal heart-health solution or as a substitute for established medical treatment.
If nattokinase fits your goals, Toku Flow provides a standardized amount of the enzyme, and it's designed to complement your care, not replace your doctor, your labs, or any prescribed treatment plan.
FAQs
Is nattokinase better than fish oil for cholesterol?
They are not equivalent cholesterol supplements. Omega-3 fatty acids are particularly well established for lowering elevated triglycerides, while nattokinase has primarily been researched for fibrinolytic and related cardiovascular effects. Neither should replace prescribed lipid-lowering treatment when it is medically necessary.
Can nattokinase and fish oil be taken at the same time?
Some people may use both, but combining them deserves caution because nattokinase can influence fibrinolytic and coagulation processes, and higher-dose omega-3 products may affect bleeding risk. Anyone taking anticoagulants, antiplatelet drugs, or other cardiovascular medications should discuss the combination with a healthcare professional.
Is nattokinase the same as omega-3?
No. Nattokinase is an enzyme produced during natto fermentation. Omega-3s are fatty acids, including EPA and DHA, found in fatty fish and fish oil. Their biological mechanisms and areas of cardiovascular research are substantially different.
*The information provided in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives. This content has not been evaluated by the Food and Drug Administration and is not intended to diagnose, treat, cure, or prevent any disease.
Sources:
A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles | PubMed
